Shingles (Herpes Zoster) (cont.)

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Are there any home remedies for shingles?

Care of the skin rash can be provided at home, and this can offer some symptom relief. Topical calamine lotion can be applied to the rash in order to decrease itching. Cool wet compresses against the rash can sometimes be soothing, and for some individuals, a compress with aluminum acetate solution (Burow's solution or Domeboro) may also be helpful. It is important to maintain good personal hygiene, avoid scratching, and to try to keep the affected area clean in order to prevent a secondary bacterial infection of the skin.

What is the duration of a shingles outbreak?

The duration of an acute shingles outbreak may vary, but typically it will last anywhere between two to four weeks. In some individuals, it may last longer.

What are complications of shingles?

Though shingles often resolves without any major problems, there are several potential complications that can arise from shingles.

Postherpetic neuralgia: This is the most common complication of shingles. This condition is characterized by persistent pain and discomfort in the area affected by shingles. The pain can last for months to several years after the rash has cleared up. This complication is thought to occur because of damage to the affected nerves. The pain can sometimes be severe and difficult to control, and the likelihood of developing postherpetic neuralgia increases with age. In people 60 years of age and older with shingles, postherpetic neuralgia will develop in approximately 15%-25% of cases. It rarely occurs in people under 40 years of age. Timely treatment with antiviral medication during a shingles outbreak may reduce the incidence of developing postherpetic neuralgia. If postherpetic neuralgia develops, there are various treatment options available including topical creams such as capsaicin (Zostrix), topical anesthetic patches (Lidoderm), antiseizure medications such as gabapentin (Neurontin), tricyclic antidepressant medications, and opioid pain medications.

Ramsay Hunt syndrome: If shingles affects the nerves of the face, this uncommon complication can lead to facial muscle paralysis, and the characteristic rash can affect the ear and the ear canal, and rarely the mouth. Symptoms may include ear pain, ringing in the ears, hearing loss, and dizziness. Though most people recover fully with treatment, some individuals may have permanent facial weakness and/or hearing loss.

Bacterial skin infection: A secondary bacterial infection of the skin blisters can sometimes develop, leading to cellulitis. This skin infection may be characterized by increasing redness, tenderness, and warmth in and around the area of the rash. Most of these bacterial skin infections are caused by either Staphylococcus aureus or group A Streptococcus bacteria. This type of infection can be treated with antibiotics.

Eye involvement: Shingles can sometimes affect the eye, a condition termed herpes zoster ophthalmicus. In certain cases, it can lead to blindness. Individuals with a rash involving the eye, forehead, or nose should have a careful eye evaluation performed by a doctor, as prompt medical treatment may be necessary.

Encephalitis: Rarely, individuals with shingles may develop inflammation of the brain (encephalitis). This condition can be life-threatening if severe, especially in people with an impaired immune system.

Disseminated herpes zoster: This serious and potentially life-threatening condition occurs most commonly in people with an impaired immune system. It is rare in individuals who are otherwise healthy. With disseminated herpes zoster, the varicella zoster virus becomes more widespread. In addition to causing a more widespread rash, the virus can also spread to other organs of the body, including the brain, lung, and liver.